POS1054 PAIN AND DEPRESSION ARE ASSOCIATED WITH NON-RESPONSE TO METHOTREXATE IN PATIENTS WITH PSORIATIC ARTHRITIS
Authors: F. R. Kasiem, L. Tucker, M. Vis, J. Luime, I. Tchetverikov, K. Wervers, J. Hazes, L. Coates, M. R. Kok
Journal: Annals of the Rheumatic Diseases (2022)

Background Psoriatic arthritis (PsA) is a heterogeneous, immune-mediated inflammatory arthritis. Methotrexate (MTX) is the first-line treatment in PsA patients, despite diverse clinical phenotypes and highly varied responses(1). As yet, it is not possible to predict MTX treatment response. The identification of demographic, clinical and psychosocial factors associated with MTX non-response, would facilitate a paradigm shift from a ‘one-size-fits-all’ approach to a more personalized medicine strategy, based on individual patient characteristics. Objectives The aim of this study was to identify demographic, clinical and psychosocial factors associated with MTX non-response 3 months after MTX initiation in adult patients with PsA. Methods Newly diagnosed, adult PsA patients were recruited to the DEPAR (Dutch southwest Early Psoriatic Arthritis cohort) study. MTX non-response was defined as patients achieving &lt;5/7 point of the Minimal Disease Activity (MDA) criteria after 3 months of MTX therapy. A logistic regression analysis was performed to identify demographic, clinical and psychosocial factors associated with MTX non-response. Demographic characteristics included age, sex, alcohol use, smoking (pack years) and body mass index (BMI). Clinical characteristics included duration of PsA symptoms, swollen and tender joint counts (66/68), Psoriasis Area and Severity Index (PASI) scores, presence of dactylitis and enthesitis scores (Leeds Enthesitis Index/Maastricht Ankylosing Spondylitis. [LEI_MASES]). Psychosocial variables included both subscales of the Hospital and Anxiety Depression Scale (HADS). Results Complete data of the variables of interest were available for 174/332 (52%) patients starting MTX monotherapy within the first year of diagnosis. Mean (SD) age was 53 (14) years and 88 patients (51%) were male. A total of 39 patients (22%) achieved MDA after 3 months of MTX therapy. Correlations between the variables and regression statistics are shown in Table 1. A significant correlation was seen between MTX non-response and enthesitis (OR 0.66, CI 0.47-0.94) and depression (OR 0.41, CI 0.25-0.66). Furthermore, the interaction of BMI with tender joint count (OR 0.95, CI 0.91-1.00) was found to be significantly correlated, whereas the independent variables were not. Table 1. Final model of the logistic regression analysis of methotrexate non-response 3 months after methotrexate initiation. Independent variables Odds Ratio 95% CI Demographic variables BMI 1.26 0.61-2.60 BMI 3 1.00 1.00-1.00 Clinical characteristics Tender joint count (68) 3.16 0.94-10.57 Enthesitis (LEI/MASES) 0.66 0.47-0.94 Psoriasis (PASI) 1.11 0.99-1.25 BMI*Tender joint count (68) 0.95 0.91-1.00 Patient reported outcomes Depression (HADS) † 0.41 0.25-0.66 Footnotes Significant values in bold face † Root transformed Conclusion Our results indicate that enthesitis, depression and the combination of a higher BMI with a tender joint count are all associated with MTX non-response 3 months after MTX initiation. Pain may be the common denominator preventing patients from achieving MDA. References [1]Gossec L, Baraliakos X, Kerschbaumer A, de Wit M, McInnes I, Dougados M, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020;79(6):700-12. [2]den Braanker H, Wervers K, Mus AMC, Bangoer PS, Davelaar N, Luime J, et al. Achieving sustained minimal disease activity with methotrexate in early interleukin 23-driven early psoriatic arthritis. RMD Open. 2020;6(2). Disclosure of Interests None declared